Complications and emergencies: pulmonary hypertensive crisis: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Complications and emergencies: pulmonary hypertensive crisis

Sample item

A patient with severe pulmonary arterial hypertension develops sudden right ventricular failure, hypotension and a falling end-tidal CO2 after induction. Which approach is most appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Oxygen, mild hypocapnia and inhaled nitric oxide

Hypoxia, hypercapnia and acidosis raise pulmonary vascular resistance and can precipitate acute right ventricular failure. Management is to give 100 percent oxygen, mild hyperventilation, inhaled pulmonary vasodilators such as nitric oxide, and to support the right ventricle with inotropes and a vasopressor to keep coronary perfusion.

Option by option

  • A. Oxygen, mild hypocapnia and inhaled nitric oxide (correct)

    Correct. Lowering pulmonary vascular resistance with oxygen, hypocapnia and nitric oxide relieves the strain on the right ventricle.

  • B. Permissive hypercapnia with a low inspired oxygen fraction

    Hypercapnia and hypoxia both increase pulmonary vascular resistance and worsen the crisis.

  • C. Rapid large-volume fluid bolus to overfill the right ventricle

    A large fluid load distends a failing right ventricle and shifts the septum, reducing left-sided output.

  • D. Esmolol to slow the heart rate and reduce demand

    A negative inotrope and slower rate would depress an already failing ventricle.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, Oxygen, mild hypocapnia and inhaled nitric oxide. Hypoxia, hypercapnia and acidosis raise pulmonary vascular resistance and can precipitate acute right ventricular failure.

Why is "Permissive hypercapnia with a low inspired oxygen fraction" not the answer?

Hypercapnia and hypoxia both increase pulmonary vascular resistance and worsen the crisis.

Why is "Rapid large-volume fluid bolus to overfill the right ventricle" not the answer?

A large fluid load distends a failing right ventricle and shifts the septum, reducing left-sided output.

Why is "Esmolol to slow the heart rate and reduce demand" not the answer?

A negative inotrope and slower rate would depress an already failing ventricle.

What concept does this question test?

It tests Complications and emergencies: pulmonary hypertensive crisis in Anaesthesia. Management is to give 100 percent oxygen, mild hyperventilation, inhaled pulmonary vasodilators such as nitric oxide, and to support the right ventricle with inotropes and a vasopressor to keep coronary perfusion.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Complications and emergencies: pulmonary hypertensive crisis?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.